Myotubular myopathy (XLMTM, OMlM 310400) is caused by mutations in the MTM1 gene located on the X chromosome and appeared at a frequency of 1/50 000 male births. Most of the patients arc affected by hypotonia and generalized muscular weakness as weIl as grave respiratory problems in the birth. In absence of an effective therapeutic treatment they are many to die during the first year of their life. My thesis work consists in developing a treatment of gene therapy for myotubular myopathy. The intravenous injection of the therapeutic vector rAAV9-DES-MTM1 into the murin model of the myotubular myopathy allows transgenic protein in the whole skeletal muscle of the body. The therapeutic protein cures the muscular phenotype rapidly after injection. At one year after treatment, the thick muscles still be cured, mice are alive and recovered a normal development. Then, I estimated the effects of the protein MTMR2, a counterpart of the myotubularine (MTM1), on muscles from mice devoid of myotubularin, as alternative at the gene therapy with MTM1. The administration of a vector AAV containing the transgene MTMR2 in the thick muscles improves, partially, the muscular phenotype. These results suggest that the increase of MTMR2 protein level MTMR2 thick muscle could be an effective treatment. Finally, I studied the role of myotubularin phosphatase activity on its therapeutic action, I compared the effect of an inactive shape of myotubularin (MTM1C375S) on muscle affected by myotubular myopathy as the effect of therapeutic transgene on the same muscle. The results show that the phosphatase activity of the myotubularin is necessary for its therapeutic activity.
